(A1206) Baseline Predictors of Hypoglossal Nerve Stimulation Treatment Response for Obstructive Sleep Apnea Patients

Introduction: Hypoglossal nerve stimulation (HGNS) is a treatment for select patients with obstructive sleep apnea (OSA). In recent years, age, sex, BMI, baseline apnea-hypopnea index (AHI), and lateral oropharyngeal wall collapse have been identified as potential predictive factors of treatment efficacy. This study assesses these factors, along with drug-induced sleep endoscopy with positive airway pressure (DISE-PAP) opening pressure (PhOP), for their impact on HGNS treatment response.

Methods: Patients who received HGNS therapy between 2014 and 2024 (n = 461, 65.3% male) at a single institution were included. Demographics, BMI, DISE findings, and AHI were collected from electronic medical records. Post hoc multivariate logistic regressions were performed in Python to assess success predictors as evaluated by: 1) post-operative AHI, 2) AHI change (post-op minus baseline), and 3) Sher15 criterion (AHI reduction by ≥50% to ≤15 events/hr).

Results: All factors were significantly predictive of post-op AHI as a success outcome measure (p < 0.001). Expected post-op AHI was 18.9% lower for female sex and 17.9% higher for lateral wall oropharygeal wall collapse (O 1 and 2). Expected post-op AHI increased by 3.6% per BMI unit, 6.8% per cmH2O increase in PhOP, and 1.2% per baseline AHI unit. Notably, increased age was predictive of higher post-op AHI (+1.4%/year), contrary to prior studies.

All factors, except PhOP, were significant (p < 0.05) predictors of change in AHI. Results aligned with post-op AHI outcomes with the exception of baseline AHI.

Age and BMI were significant (p < 0.05) predictors of Sher15 success. However, all coefficients were directionally consistent with AHI change predictions. Each year of age and unit of BMI reduced success odds by ~2.2% and 5.4%, respectively.

Conclusions: Lateral wall collapse, male sex, and higher BMI, opening pressure, baseline AHI, and age correlated with reduced treatment response. These findings underscore the importance of a comprehensive patient evaluation to optimize patient selection, outcomes, and counseling.